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, """ b,CEIlETEIlV_No.. ....... ".' .~.,..~J.H!.~.~.. .... ...... Lots493 & 104
325 00 . ... . .. B1t. , Un.
ListP~ce$"'65'O':'O'O""'~ ~~No.BurialS.paCCl.................. Eli b h C K h 1233
NiltPlUd$ .................. I49DlUI*tponaittod..,......~............. za et . oc
, 955 33rd Ave.
Vero Beach, Fl.
NO.
'John R. Kock interred
Lot 9 - 8/17/89
32960
i>(D&~ a"'. t;bJa.1lDc tOf CUt Reclord 0DlJ)
atitl1 nf &thastian
Qtrmrtrry
Irrll
1233-.
NO.
THIS INDENTURE KADE TWt
17th
.......................
day of ............A~~.~.~~...................... A. D.. 18.~?...
between the CIty of Sebutlan, a munJclpal corporatloQ exJatlne under the laws of the State of Florid.. .s Grantor alld
Elizabeth C. Koch
.... ........'.......................,..........,............................................................................................
955 33rd Ave.Vero Beach Fl. 32960
.. ,. '................ ....... .................... ................ I............. ......... .'...... ... ......... ...........o............o...........
Indian River Florida
of the Coun17 of ............................................. an'] State of .......................................................
u Grantee, WITNB$SETH. $ 6 50 . 00 . .
That the Grantor for and in consideration of the sum of S .......... ~ . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, d~s by this instrument grant, bargaiD, sell, release, convey and conium unto the Grantee.. .l)~r.. hein.legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s)..~ . & ~ ~ Block, . . .41.. , UNIT ....4........ , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 65 of the public records in the .office of the Clerk of the Circuit Court of S1. Lucie County of Florida; said land now lying and being
in Indian River County, Florida.
To Have ~ to Hold the samo foJever; pIOvided that said property sba1I be used solely and exclusively fOr the Intermont of the human dead and sba11
be used, kept and maintained at aD times in acccmlaDco with the rules and resuJatlons, ordinances and resolutions of tho City of Sebastian, Florida, hereto-
fore. now and ~reaft. adopted or provided for the government and operation of said cemetery. The conditions, restrictions and Ieq,uirements contained
in this instrument sba11 be covenants running with the land. In the event of the failure of the owner of any property situated within said cemetery to ob-
serve and comply with iueb ~ regulations, resolutions and ,ordinances and the conditions of the deed of conveyance thereof then the title of such owner
in and to said property sba11 terminate and the same sba11 revert to the City of Sebastian. Florida.
IN WITNESS WHEREOF, The said party of the first part has caused this instrument to be executed in its name and on its behalf by its Mayor and
attested by its City Clerk and its corporate seal to be hereto. affixed, the day and year first above written.
A,.....4.,. · fJit ':.DdaML~........
'-K'.~ Ci17 Oerk .
CITY OF SEBASTIAN. FLORIDA
B, .~l.~....,..:.....
M..,.or
Signed, Sealed and Delivered
In the Presence o~ ~
~~.. .
...... ;......... ......... ................................
{$~rM;V.~~.....
(GIlt" Jieal)
STATE OF FU)RIDA
COUNTY OF INDIAN RIVER
17th. August 89
I HEREBY CERTIFY. That OIl tb1s ........................d.y of ..................................................., 18.~....~._
Richard B. Votapka . Kathryn M. O'Hal1oran
before me personally appeared ........................................................... and ............................ . . . . . . . . . . .
respectively' Mayor and City Clerk of the CI17 of Sebastien, It municipal corporation under the laws of thc State of Florida to me knowQ
to be the individuuls And offiCers described 10 and who executed the forl'golng coaveyanc:e to
ElizabethC. Koch
.......................,..................................................................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ... . . . . ... . . . . . ... .. and.. .-verally acknowledged the exec:uUon thereof to be theJr free aet and deed
as such officers thereunto duly authorlled; and that the. Official. selll. of. said corporation Is duly .ffixed thereto, and the Slid conveyance
is the act .nd deed of said corporation. . . ..;.> .
WITNESSmyslgn.ture and offJcial seal at SebuUa.n,.lo ~ Countx.,,-of Indl.n River end State of Florida. the day and ,ear
last aforesaid. _:'
.,'" . 4 j~-" ~JJ:d. 0 c
, ~~~~~'":iA~...........:.
My commlssloQ expires. Hotal'" rublic. Stilte of norider
My Commission Expires Dee. 10, 1992
Jondod Tllrv Troy fain . lnlv,anceInc"
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650.00
NetPaid$ ..................
John R. Kock interred
Lot 9 - 8/17/89
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NO.
12~3
..._ ........... . .. ..' .. .. ." .... .. .. Eli za be the. ito ch
955 33rd Ave.
Vero Beach, Fl. 329E
(Data abo1'e thll Bne for CltJ 1\eCOrcl oolJ)
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City of Sebastian
POST OFFICE BOX 780127 D SEBASTIAN. FLORIDA 32978
TELEPHONE(407)S8~~
August 31, 1989
.Mrs. Elizabeth C~'Koch
955 33rd Avenue
Vero Beach,F1orida 32960
Dear Mrs. Koch:
Enclosed is Cemetery Deed No. 1233 for Lot(s) No.9 & 10 , Block 43,
Unit 4.. If you wish to have this deed recorded, you may do so at
the office of the Clerk of the Circuit Court, 2145 14th Avenue,
Vero.Beach, Florida.
Also eQclosedis a form - Return for Transfers of Interest in
Florida Real Property - which must be filled out by you and com-
pleted by the office of the Clerk of the Circuit Court.
We are enclosing two copies of Receipt No. and ask that you
sign and return to us the copy marked with an "X" and retain the
other copy for your records. A stamped, self-addressed envelope
is provided for your convenience.
Very truly yours,
-t~I\J,
Elizabeth Reid
Administrative Secretary
LR
Enc.
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THE SEBASTIAN CEHE'l'ERY
City of Sebastian
Sebastianl Florida
RECEIPT IS HEREBY ACKNOfiLEDGEDOF THE SUN OF:
..(1 ~ Ifun'R IE j) 1-, Fr'1 /f /> oio 0
FRON: P'/.-I""]"AOe:rJf ~. KoC.H,
955 )~il4 /h!G.
..---
Dollars ($ 6.50. 00
)
Ve~o f>el/C-f7,
F'-. 32..560
on this (?~ day of /luG-v 5r ,-.19~'1 for the purchase of the fOllowing
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s) /I q.J. 10 Block# tf.3 Unit# q.
Purchase price:1hRee Hv#l)Rn t;;EJ/f"'1- F;v~.k./1,llarS($ (, S"D. IJD)
Terms and' conditions of sale:
This contract shall be bind.i.ng upon both parties, the seller and the purchaser, when
approved by the owner of the property above described.
I, or we, agree to purchase the above described property on the terms and condi tions
stated in the foregoing instrument:
X Dih.bJ t. K6~
The Ci ty of Sebastian agrees to sell the above mentioned property to the above named
purchaser(s) on the terms and conditions stated in the above instrument.
~ -.k4 ~~
Ci ty of s%stian
4:/Pf;rJ+~. '
~tness
. .
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.
.
JOHN R. KOCH AND/OR
ELlZABETHC. KOCH,
955 . 33RD AVENUE, 569-5394
VERO BEACH. FL ~
. I PAY TO lHE
I ORDER OF
.
1682
63-8598 22
Mff
DOLLARS
U~A
as
FOR;(, ~ ~ z.-of~ ~J-'Ol&1--'<.Inl VI,r{-
:'l: 2 b fla 5 qa 21:0000000 2 q qa ?Olll
JoHtl lrof" ~
hvf. .' ~/n(n~
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, STATE OF FLORIDA .
'rn!f .EPA~TMENT OF HEALTH & REHABILI.e SERVICES
LII.D.I VITAL STATISTICS
DI~~:::;~~J~~~::;;D APPLICATION FOR BURIAL-TRANSIT PERMIT
.~,- '-?'''t'.;~;.'-,.c:--,,_,cz,_,,_;:,:,,~~:,~~~;;t.,;,~'Fli~~~",":"i0':-; 'Y'"fJf~_-;' .,,'
A.
1. Name of
Deceased
(Type or Print)
First
J..tJ
/!; 1j 3
Cl1
Middle
Last
JOHN
ROBERT
KOCH
DATE
OF
DEATH
Month Day' Year '
2. Place of Death
County
,City, Town or Location
AUGUST . 14 1989
Name of (If neither, give street address)
Hosp. or
INDIAN RIVER VERO BEACH Inst. INDIAN RIVER MEMORIAL HOSPITAL
3. Name of Medical 0 Physician '. ' " 'Address Phone Number
Certifier NOOR MERCHANT, M.D., 0 Medical Examiner 777 37TH STREET 567-2332
4. Funeral Home/ Name Address Phone Number (Area Code)
Oirect Disposer STRUNK FUNERAL HOME 916...17TH STREET '" VEROBEACH 407 562 2325
5. Check a 0 The medical certification has been completed and signed. A completed certifi,cate of death accompanies
Appro. this application. '
priate
Box
b 0
DR. MERCHANT was cOntacted on 8/16/89 within 72
hours after death. He/she verified that this death was from natural causes, that there was no accident nor
other external cause of death, anq, that DR. MERCHANT will complete
.a.!l,~$i91l,lh~r:',~i~kf.'~~~t!~ij,M'R~~~~..g.ft,~~i!~o.:~ .:, ,', ,', " ",' ,. c' ," "
c 0 . , was coritactedon . He/she, V~rified that
, Medical Examiner, will complete and sign the
medical certification.
B.
Fla. Lie. No./Reg. No.
C!)W"r
Date Signed
6. Funeral Director/
nirA,..t n;cpnser
~ ----
8/14/89
Permission is hereby granted to dispose of thisbody,"
o A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct
Disposer Report" will be filed with the LocaIFlegistr~.of the County in which death occurred.
o No extension of time for . ing the death certificate'requested. '
Registrar or
Subregistrar Signature
Permit No. ] 10-89-17]
()t
Date
Issued: 8/1 &/89
Data Certifijate /
Due: 8 18 89
C.
'. ..,: ".,- ".:: ", ;j' "" ''''':':.. :,-',-." .. .'" '<,'..: '," ",'-- - .. " ',-:',' :-.. ......- ,':,.'" '., .." '.,' .. .." " , ..
AUTHORIZA "nO~ffor CREMATION, DISSECTION or BURIAL':"'A T -SEA
., _,'I
Signature
or
Medical Examiner,
, Medical Examiner
Date
. , gave authorization by telephone to
,.,' ". ,. , ..-.. . ." ,fl:trl~!~IDirt:.!;~9,rtQirect pisposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting periOd of 48 hours after
death is required for all cremations. 'n '. " " ,
t:
D.
CEMETERY OR CREMATORY " " , t ~
Place of Di$PO$;'iO~o1'.J ~~"',.-~
Date of Disposition / i, 17'1',
.
This permit must be endorsed by the Sexton or person.in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton)
and returned within 10 days to the local County Health Department in the County where disposition occurred.
HRS Form 326, Oct 87 (Replaces May 86 edition which may be used)
(Stock Number: 5740-000-0326-2)
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